The UK government recently took a huge step forward for public health by committing to introduce standardised packaging for cigarettes. As we’re poised to become the first country in Europe to adopt standard packs, we’re pleased to publish a guest post by Linda McAvan, Member of the European Parliament (MEP).

Linda McAvan MEP

Linda has helped to steer a key piece of tobacco control legislation –the Tobacco Products Directive – through the inner workings of the European Union’s policy machine. Here she gives her take on why the new law is important for people in the UK and across Europe.

The UK government’s commitment to standard packs goes hand in hand with a new European Union (EU) law that will protect people across Europe from the harm caused by tobacco.

The EU Tobacco Products Directive (TPD) aims to make cigarettes less attractive to the hundreds of children who start smoking in the UK every day – and will mean big changes to packaging and products over the next couple of years.

Following overwhelming support from the European parliament, EU countries now have two years to bring national law in line with the directive.

Here are the 10 most important changes to look out for:

Larger graphic health warnings, covering two thirds of the front and back of packs: the bigger the warning, the more effective it is at deterring children and non-smokers. Warnings would have to go at the top of cigarette packs, with the branding squeezed into the remaining space at the bottom. The UK government has announced that it’s ready to go further by removing branding altogether.

A ban on flavoured cigarettes and rolling tobacco. Gimmicky products like chocolate, vanilla, or “click” cigarettes with menthol capsules in the filter – all products that tempt young people – will come off the market.

The slim lipstick style packs – so attractive to girls – will be banned, although slim cigarettes will continue to be allowed on the market, as there was, unfortunately, no majority to ban these.

Cigarette packs will have to be a standard shape, and contain at least 20 cigarettes. So the “pocket money” packs of 10 cigarettes, as well as small packs of rolling tobacco, will disappear. Price is a big factor for young people, and getting rid of small packs is one way of raising the price barrier.

Packs with novelty openings – like those that slide open – which are attractive to boys will be banned – packs will have to have a standard, flip top or side-hinge opening.

The tar, nicotine and carbon monoxide labelling will come off packs. These gave smokers the false impression that a lower tar choice is somehow less harmful, whereas in reality, smokers simply compensate in the way they smoke.

There’s a lot more we need to learn about what is actually in a cigarette, and what effect the 600 plus additives have on our health. The tobacco industry will be required to produce studies on additives, and pay for them to be independently peer-reviewed. This could ultimately lead to bans on substances which make smoking more addictive and damaging to health.

New anti-illicit-trade measures: a hologram on cigarette packs to crack down on counterfeiting; and a track-and-trace scheme to reduce smuggling by allowing authorities to track the movement of cigarettes along the supply chain.

E-cigarettes will be regulated for the first time. The law offers two routes to put e-cigarettes on the market: as a medicine or as a consumer product subject to safeguards. If companies choose to make a claim that their e-cigarette helps smokers quit, they will have to seek a medicines licence – and then the strength and advertising restrictions do not apply.

But perhaps the biggest change of all is the Tobacco Products Directive itself – setting a benchmark across Europe for tobacco control. My hope is that countries across Europe, not just the UK, will strive to go beyond the law’s minimum requirements and do more to protect people, especially children, from the harm caused by tobacco.

Public pressure was key to getting this law agreed in time for the European elections – and many Cancer Research UK supporters played a crucial part by contacting MEPs ahead of the vote.

But the job is not done yet: we need to make sure the law is implemented fully, and before the May 2016 deadline.

Given the inevitable fight back from the tobacco industry, and their history of challenging these laws in court, the earlier we do this the better.

Linda McAvan MEP

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This tobacco directive is insane, pure and simple. Who do you think, you’ll help with this? Young smokers? Not likely. On the contrary: You are stigmatizing a huge group of poor and weak people who need to smoke for relief, by attaching ugly pictures to them, so that the “normal” (nonsmoking) community will hate them more. Do you really think that is a good idea? Hardly. It is dehuman, and history will hold you accountable.

Below is the abstract of a worldwide survey on e-cig use, it’s main results should provoke sober reflection at CRUK. Your policy at present will result in many avoidable deaths.

Background: Electronic cigarette (EC) use has grown exponentially over the past few years. The purpose of this survey was to assess the characteristics and experiences of a large sample of EC users and examine the differences between those who partially and completely substituted smoking with EC use. Methods: A questionnaire was prepared, translated into 10 different languages and uploaded in an online survey tool. EC users were asked to participate irrespective of their current smoking status. Participants were divided according to their smoking status at the time of participation in two subgroups: former smokers and current smokers. Results: In total, 19,414 participants were included in the analysis, with 88 of them (0.5%) reported not being smokers at the time of EC use initiation. Complete substitution of smoking was reported by 81.0% of participants (former smokers) while current smokers had reduced smoking consumption from 20 to 4 cigarettes per day. They were using ECs for a median of 10 months. They initiated EC use with a median of 18 mg/mL nicotine-concentration liquids; 21.5% used higher than 20 mg/mL. Only 3.5% of participants were using 0-nicotine liquids at the time of the survey. Former smokers were highly dependent (Fagerström Test for Cigarette Dependence = 7) and were heavier smokers (21 cigarettes per day when smoking) compared to current smokers. The most important reasons for initiating EC use for both subgroups was to reduce the harm associated with smoking and to reduce exposure of family members to second-hand smoking. Most considered ECs as less harmful than tobacco cigarettes, while 11.0% considered them absolutely harmless. Side effects were reported by more than half of the participants (59.8%), with the most common being sore/dry mouth and throat; side effects were mild and in most cases were subsequently resolved (partially or completely). Participants experienced significant benefits in physical status and improvements in pre-existing disease conditions (including respiratory disease such as asthma and chronic obstructive lung disease). Being former smoker was independently associated with positive effects in health and improvements in disease conditions. Conclusions: The results of this worldwide survey of dedicated users indicate that ECs are mostly used to avoid the harm associated with smoking. They can be effective even in highly-dependent smokers and are used as long-term substitutes for smoking. High levels of nicotine are used at initiation; subsequently, users try to reduce nicotine consumption, with only a small minority using non-nicotine liquids. Side effects are minor and health benefits are substantial, especially for those who completely substitute smoking with EC use. Further population and interventional studies are warranted.

The EU Directive favours sealed and standardised electronic cigarettes that offer a very limited range of flavours and look like ‘real’ cigarettes. The great majority of their users continue to smoke, albeit usually at a reduced rate. Not surprisingly, they are the type of product that tobacco companies are enthusiastically buying into.

Consumers who become bored with them either return to exclusive tobacco use or, if they learn of their existence and have the opportunity to try several out, tend to move on to more evolved ‘2nd & 3rd generation’ products, which offer flexibility of operation and a far wider range of flavours. Their users tend to abandon tobacco altogether, as discovered by a recent Wells Fargo report, or as testified by users themselves on their various forums.

Sadly, Ms McAvan’s Directive discourages and in many respects bans these more evolved products. It promotes instead the relatively inefficient ones of the 1st generation that closely resemble and encourage the continuing use of tobacco cigarettes. No wonder that the clauses in the Directive concerning electronic cigarettes have been welcomed by the tobacco industry.

“Given the inevitable fight back from the tobacco industry, and their history of challenging these laws in court, the earlier we do this the better.”
Why ever should the tobacco industry “challenge these laws”? The Tobacco Products Directive will never do any harm to their business, as you involuntary highlight in your 10 “reasons”: do we really believe that a different package and some pictures will reduce tobacco consumption? No, you know that they will not: that’s why you like the directive

The only conclusions i have drawn from this rubbish is CRUK is either in the pockets of the big pharma companies or are utter morons ,incoming legislation as it stands favours nobody but major multinational’s pharma and perversely tobacco handing them the e cig industry on a platter…..you should hang your heads in shame

Why don;t you come clean CR-UK – like your branches across the world you hate the e-cig and will bow down to Pharma and everyone else who fund you – you hate it because it’s doing the job people donate to you to do, it’s cutting cancer. I don’t know how many jobs it will cost you and I really don’t care; I’ve fought e-cig legislation and will continue to my last breath – I can sleep at night, can you?

“E-cigarettes will be regulated for the first time. The law offers two routes to put e-cigarettes on the market: as a medicine or as a consumer product subject to safeguards. If companies choose to make a claim that their e-cigarette helps smokers quit, they will have to seek a medicines licence – and then the strength and advertising restrictions do not apply.”
This is just plain crazy. The medicine route will produce a high nicotine 1st generation device. Unsatisfactory and will probably send most people back to cigarettes. Good for the tobacco companies, drug companies, and the treasury. The better 2nd and 3rd generation devices are much more efficient, producing a more satisfying vape with lower nicotine levels. 12mg (1.2%) nicotine level in a good device will be more effective than a 36mg (3.6%) 1st generation cig-alike. Not so good for tobacco and drug companies or the treasury. So its really all down to the money. Maintain the status quo at any expense, keep the brown envelopes coming, even the at the expense of peoples lives. I see a huge black market looming, and yes an awful lot of consumers will use it until common sense prevails.

Effectively banning e-cigs under the TPD and other directives, regulations and laws is the exact opposite of CRUK’s statement –

“Cancer Research UK is the world’s leading charity dedicated to cancer research. All our activities are directed towards our ultimate goal of beating cancer.”

Where is CRUK’s research into e-cigs?
Why do CRUK believe that people smoking tobacco rather than an e-cig is better?
Why does CRUK believe that Linda McAvan even knows what she talks about? or is CRUK actually telling her what to do politically.
How much money do Big P & Big T use to influence CRUK?

Perhaps there should be a public enquiry!

In essence, CRUK should be helping encourage tobacco smokers to quit by using e-cigs.

As a result of CRUK’s so called policy on e-cigs, I will not give them any more money.

E-sigs got me off the tobacco after 42 years I tried all the other stuff you can get off the shelf in the shops and it did not good they should be left. As they are you find the pub that let you use them are full again people should be educated to what they are

Yet another own goal for pharma-driven cruk. While you ignore the evidence on e-cigs, there is no hope for you. Even some of your own people & ASH support e-cigs – and most see the TPD in relation to ecigs for what it is – concerned only with pharma profits & taxation. CRUK used to be more concerned about health promotion than protecting their paymasters interests. Shame on you.

Oh dear, wrong on so many counts. I have used vaping devices for two years now and will have to go black market unless you change your tack, read and digest the facts from all the sources not just cherry pick the ones that suit your ends (oh dear pun intended).

i smoked for 20 years, never have i seen ‘chocolate flavour’ cigs, the only gimmick is that inclusion. Menthol ban as easy to dodge as popping a mint in your mouth before lighting up.
health warnings, seeing the same images day after day acclimatises a smoker, after a short time they don’t even register.
Could go on but its more of the same, ecigs are your best bet to curb smoking rates and the TPD pretty much guts that market, with an science free ideological puritan approach. You had an open goal, you blew it

It is worth pointing out that the TPD by the EU’s own estimation is only anticipated to reduce smoking rates by 2% over the next 5 years, hardly a victory over smoking.

In fact the TPD will result in a net increase in smoking deaths compared to doing nothing at all. The restrictions on e-cigs are medical regulation by the back door.

20mg/ml limit – arbitrary figure with no scientific basis, the scientist involved formally complained that his work had been distorted. This makes the heaviest of smokers less likely to switch successfully and more likley to die.
Non leak cartridges – If you hit a nuclear waste container hard enough, it will leak. This simply provides a convenient excuse to basically ban most models.
10ml refill maximum size – another arbitrary figure with no basis in either science or common sense, especially as the same directive bans smaller real cig packages in favour of larger ones.

The list goes on and contains enough requirements to remove most, if not all current products. The only people who are happy are Big P who will not start to a dramatic drop in their smoking related disease treatments & Big T who will be one of the few who have a chance to meet the new requirements.

Regarding ecigs,I note the recent ASH survey that there are currently 2.1m GB users – 0.7m exclusively.Last year’s research from R West et al showed 0.146m quitters attributable to cessation services over the 10 years to 2011.

I also note the MHRA estimate of regulation cost in the range £100k-£2m (excluding GMP costs) and wonder how many of the 5,000 current ecig products(per Luciana Berger) would survive,given average annual sales of £40k per product.

With regard to the TPD’s consumer regulation,we do not know the cost per product and cannot assess its impact(an EU requirement?).With all advertising and marketing banned,it is difficult to see how this segment of the market can survive.

It is hard to escape the conclusion that ecigs are deemed harmful and tobacco control would rather we smoked(if unable to abstain) instead.

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